The purpose of this document is to describe three standards for health care organizations that seek accreditation by Comfort Matters Dementia Care Education, Beatitudes Campus, Phoenix, AZ. Standard 1 is about organization staff-medical care providers; standard 2, care practices; and standard 3, the milieu.
Standards for Accreditation of Health Care Organizations
By Comfort Matters Dementia Care Education
Standard 1. Expectations of organization staff-medical care providers*
With respect to program competencies
- Organization staff and medical care providers attain and employ the Comfort Matters competencies for their job roles. Competencies include knowledges, skills, and abilities based on “know the person,” “meaning of comfort,” and “staff empowerment”—key concepts in Comfort Matters. Example competencies are:
- Describe the connection between staff actions and their positive or negative impact on the environment of the person with dementia.
- Demonstrate how to honor the food preferences of a person with dementia.
Although each job role has specialized competencies, it shares competencies with other job roles as well. Shared competencies increase the efficacy of staff efforts.
- As new staff join the organization, they are expected to participate in continuing education in which they attain and employ the Comfort Matters competencies for their roles.
Consistent assignments for service
- Staff from all departments in the organization are on consistent assignments that allow them to see and interact with the same persons with dementia almost every time they are at work. These assignments also encourage staff to know the persons’ families.
Staff organization and communication
- Neighborhood teams, comprised of all staff members in a particular geographic area, address the immediate needs of persons with dementia and their families. Team members ask questions and seek common goals that promote the well- being of persons with dementia and their families, as well as their staff colleagues. Moreover, regardless of their positions or departments, all neighborhood team members have equal voices in decision-making.
- Core teams, consisting of representatives from neighborhood teams, deal with policy- and work-flow issues related to persons with dementia, their families and staff. Core team members alert their colleagues to issues and then receive pertinent input about these issues from individuals and groups, including leadership personnel. Afterward core team members use problem-solving approaches to obtain solutions. Core teams promote the well-being of persons with dementia and their families and also their colleagues. Team members have equal voices in decision-making.
- Leadership personnel are members of these teams. These individuals encourage staff members to participate fully in team processes by limiting their own remarks in meetings to offering support unless the staff is operating out-of-bounds, supporting the team and leader outside of meetings, and understanding that fully functioning teams improve the leader’s role.
- Each team meets at a regularly scheduled time for discussions of its business and communicates with its own members. In addition each team communicates with other teams, making sure that all team members regardless of the hours/shifts they work can participate in decision-making. An effective communication system for all staff is necessary for their empowerment, a requirement of Comfort Matters organizations.
* In many cases medical care providers are not on staff at health care organizations.
Standard 2. Care practices
Comfort Matters care practices encompass persons with dementia and their families. All practices have comfort as their goal.
- Each person with dementia has a life history document prepared by the person’s family with staff assistance, if needed. This life history is available to all staff who use the information in activities of daily living and in other interactions with the person.
- Staff and medical care providers encourage persons with dementia to make their own decisions and to participate in their care, whenever possible.
- Care for each person with dementia is outlined in a plan based on a careful assessment of the person’s actual and anticipated needs. Proposed interventions and evaluations of the outcomes consistent with Comfort Matters Care policies and procedures are included. The plan is shared with the person’s family in a care conference.
- The neighborhood team works together on developing and using road maps for individuals and or groups of persons with similar needs for comfort.
- Persons with dementia are free of pain as indicated by their medical records that show use of pain observation tools and nonpharmacologic and pharmacologic methods for addressing pain. These records are in accord with the organization’s policies and procedures for pain.
- Whenever persons display dementia-related actions such as “calling out,” “rejecting care,” and the like, staff move quickly to relieve the cause of these actions using soft approaches consistent with Comfort Matters care practices.
- A gradual dose reduction plan, using CMS guidelines, is in place for persons with dementia who receive psychotropic medications.
- Staff and medical care providers answer questions from family members about their person and offer encouragement, whenever possible.
- Staff and medical care providers provide information about advance care plans to families/surrogate decision makers and then encourage the decision makers to formulate written plans that detail their intentions for their person with dementia.
- Staff and medical care providers give information to families/surrogate decision makers about potentially burdensome medications and treatments such as daily blood pressure readings, routine blood tests, and others or options regarding hospital and emergency room utilization. Then they encourage the decision makers to make plans that detail their intentions for their person with
Standard 3. Milieu
Persons with dementia have an absolute right to live in an environment that not only cares for their needs, but also encourages their autonomy, respects their individuality, and demonstrates a genuine commitment to improving the quality of their lives.
- Persons with dementia must be able to dine in a venue suitable for their needs. They must be able to eat foods they enjoy at whatever time they are hungry.
- The dining area must be lighted appropriately, be at a comfortable temperature and be free from offensive odors.
- Staff identify challenges with dining for persons with dementia and arrange remedies for them. Dining styles, whether tray-line, restaurant or family-style, must fit with needs of persons with dementia.
- Contrasts must be noticeable among table, table coverings, dinnerware and food to aid persons with dementia. Napkins, rather than clothing protectors, should be used.
- Staff and or family who dine with persons with dementia engage with them in ways of interest to the persons.
- Food and drink specific to the preferences of persons with dementia must be available around the clock. Staff have input into the choices of snacks available to these persons.
- Both stimulating and calming experiences must be available to persons with dementia throughout their day. Ongoing engagement with persons with dementia is offered by all staff regardless of their roles and the engagement must represent the person’s interests.
- Staff are responsible for determining when television/music in common areas is comfortable for persons with dementia. Staff also monitor other sources of noise/confusion, such as equipment, large numbers of people movements, etc.